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. 2008 Sep 9;31(9):407–412. doi: 10.1002/clc.20304

Endogenous B‐type Natriuretic Peptide: A Limb of the Regulatory Response to Acutely Decompensated Heart Failure

Robert E Hobbs 1,✉, Roger M Mills 2
PMCID: PMC6653423  PMID: 18781599

Abstract

Acutely decompensated heart failure (ADHF) represents an episodic failure of cardiorenal homeostasis that may resolve with upregulation of natriuretic peptides, bradykinin, and certain prostacyclins. B‐type natriuretic peptide (BNP) has multiple favorable effects, including vasodilation, diuresis, natriuresis, and inhibition of vascular endothelial proliferation and cardiac fibrosis. By antagonizing the effects of activation of the renin‐angiotensin‐aldosterone system (RAAS) and the sympathetic nervous system in volume overload, the endogenous BNP response may help rescue patients from episodic ADHF. Although knowledge of BNP physiology is expanding, we still have limited understanding of the heterogeneity of proBNP‐derived molecules, including active 32 amino acid BNP and less active junk BNP forms. Emerging evidence suggests that in ADHF, the endogenous BNP response is overwhelmed by neurohormonal activation. This relative BNP deficiency may also be accompanied by physiologic resistance to BNP. Additionally, abnormalities of BNP production may result in a lower proportion of active BNP relative to less active forms that may also be detected by point‐of‐care tests. Improved detection of the various BNP species may clarify these concepts and facilitate improved clinical management of ADHF. Copyright © 2008 Wiley Periodicals, Inc.

Keywords: acute coronary syndromes; acutely decompensated heart failure; B‐type natriuretic peptide; cardiovascular biochemistry; cardiovascular pathology; central nervous system, heart disease; heart failure

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References

  • 1. Chen HH, Burnett JC Jr: The natriuretic peptides in the patho‐ physiology of congestive heart failure. Curr Cardiol Rep 2000; 1: 198–205. [DOI] [PubMed] [Google Scholar]
  • 2. Adams KF Jr, Mathur VS, Gheorghiade M: B‐type natriuretic peptide: from bench to bedside. Am Heart J 2003; 145: 534–546. [DOI] [PubMed] [Google Scholar]
  • 3. Felker GM, Adams KF Jr, Konstam MA, O'Connor CM, Gheorghiade M: The problem of decompensated heart failure: nomenclature, classification, and risk stratification. Am Heart J 2003; 145(2): S18–S25. [DOI] [PubMed] [Google Scholar]
  • 4. Adams KF Jr, Lindenfeld J, Arnold JMO, Baker DW, Barnard DH, et al.: HFSA 2006 comprehensive heart failure practice guideline. J Card Fail 2006; 12(1): e1–e122. [DOI] [PubMed] [Google Scholar]
  • 5. Nieminen MS, Böhm M, Cowie MR, Drexler H, Filippatos G, et al.: Guidelines on the diagnosis and treatment of acute heart failure–full text. Eur Heart J 2005; 26: 384–416. [DOI] [PubMed] [Google Scholar]
  • 6. Bocchi EA, Vilas‐Boas F, Perrone S, Camano AG, Clausell N, et al.: I. Latin American Guidelines for the assessment and management of decompensated heart failure. Arq Bras Cardiol 2005; 86(Suppl. III) 49–95. [PubMed] [Google Scholar]
  • 7. Cea LB: Natriuretic peptide family: new aspects. Curr Med Chem Cardiovasc Hematol Agents 2005; 3(2): 87–98. [DOI] [PubMed] [Google Scholar]
  • 8. D'Souza SP, Davis M, Baxter GF: Autocrine and paracrine actions of natriuretic peptides in the heart. Pharmacol Ther 2004; 101: 113–129. [DOI] [PubMed] [Google Scholar]
  • 9. Berkowitz R: B‐type natriuretic peptide and the diagnosis of acute heart failure. Rev Cardiovasc Med 2004; 5(Suppl. 4) S3–16. [PubMed] [Google Scholar]
  • 10. Tamura N, Ogawa Y, Chusho H, Nakamura K, Nakao K, et al.: Cardiac fibrosis in mice lacking brain natriuretic peptide. Proc Natl Acad Sci U S A 2000; 97(8): 4239–4244. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 11. Houben AJHM, van der Zander K, de Leeuw PW: Vascular and renal actions of brain natriuretic peptide in man: physiology and pharmacology. Fundam Clin Pharmacol 2005; 19: 411–419. [DOI] [PubMed] [Google Scholar]
  • 12. Zannad F: Acute heart failure syndromes: the ‘Cinderella’ of heart failure research. Eur Heart J 2005; 7(Suppl. B): B8–B12. [Google Scholar]
  • 13. Chung P, Hermann L: Acute decompensated heart failure: formulating an evidence‐based approach to diagnosis and treatment (Part I). Mt Sinai J Med 2006; 73(2): 506–515. [PubMed] [Google Scholar]
  • 14. de Bold AJ, Ma KK‐Y, Zhang Y, Kuroski de Bold ML, Bensimon M, et al.: The physiological and pathophysiological modulation of the endocrine function of the heart. Can J Physiol Pharmacol 2001; 79: 705–714. [PubMed] [Google Scholar]
  • 15. Gardner DG: Natriuretic peptides: markers or modulators of cardiac hypertrophy? Trends Endocrinol Metab 2003; 14(9): 411–416. [DOI] [PubMed] [Google Scholar]
  • 16. Goetze JP: Biochemistry of pro‐B‐type natriuretic peptide‐derived peptides: the endocrine heart revisited. Clin Chem 2004; 50(9): 1503–1510. [DOI] [PubMed] [Google Scholar]
  • 17. Luchner A, Stevens TL, Borgeson DD, Redfield M, Wei C, et al.: Differential atrial and ventricular expression of myocardial BNP during evolution of heart failure. Am J Physiol 1998; 274: H1684–H1689. [DOI] [PubMed] [Google Scholar]
  • 18. McCullough PA, Omland T, Maisel AS: B‐type natriuretic peptides: a diagnostic breakthrough for clinicians. Rev Cardiovasc Med 2003; 4(2): 72–80. [PubMed] [Google Scholar]
  • 19. Shimizu H, Masuta K, Aono K, Asada H, Sasakura K, et al.: Molecular forms of human brain natriuretic peptide in plasma. Clin Chim Acta 2002; 316(1–2): 129–135. [DOI] [PubMed] [Google Scholar]
  • 20. Shimizu H, Masuta K, Asada H, Sugita K, Sairenji T: Characterization of molecular forms of probrain natriuretic peptide in human plasma. Clin Chim Acta 2003; 334(1–2): 233–239. [DOI] [PubMed] [Google Scholar]
  • 21. Heublein DM, Huntley BK, Boerrigter G, Cataliotti A, Sandberg S, et al.: Immunoreactivity and guanosine 3',5'‐cyclic monophosphate activating actions of various molecular forms of human B‐type natriuretic peptide. Hypertension 2007; 49: 1114–1119. [DOI] [PubMed] [Google Scholar]
  • 22. Boerrigter G, Costello‐Boerrigter LC, Harty GJ, Lapp H, Burnett JC Jr: Des‐serine‐proline brain natriuretic peptide 3–32 in cardiorenal regulation. Am J Physiol Regul Integr Comp Physiol 2007; 292(2): R897–R901, Epub 2006 Oct 26. [DOI] [PubMed] [Google Scholar]
  • 23. Hawkridge AM, Heublein DM, Bergen HR III, Cataliotti A, Burnett JC Jr, et al.: Quantitative mass spectral evidence for the absence of circulating brain natriuretic peptide (BNP‐32) in severe human heart failure. Proc Natl Acad Sci U S A 2005; 102(48): 17442–17447, published online before print as 10.1073/pnas.0508782102. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 24. Liang F, O'Rear J, Schellenberger U, Lungkuo T, Lasecki M, et al.: Evidence of functional heterogeneity of circulating B‐type natriuretic peptide. J Am Coll Cardiol 2007; 49: 1071–1078. [DOI] [PubMed] [Google Scholar]
  • 25. Rademaker MT, Richards AM: Cardiac natriuretic peptides for cardiac health. Clin Sci (Lond) 2005; 108: 23–36. [DOI] [PubMed] [Google Scholar]
  • 26. Hobbs RE, Mills RM, Young JB: An update on nesiritide for treatment of decompensated heart failure. Expert Opin Investig Drugs 2001; 10(5): 935–942. [DOI] [PubMed] [Google Scholar]
  • 27. Silver MA: The natriuretic peptide system: kidney and cardiovascular effects. Curr Opin Nephrol Hypertens 2006; 15: 14–21. [DOI] [PubMed] [Google Scholar]
  • 28. Chen HH: A state of brain natriuretic peptide deficiency or resistance or both! J Am Coll Cardiol 2007; 49(10): 1079–1088. [DOI] [PubMed] [Google Scholar]
  • 29. Boerrigter G, Burnett JC Jr: Recent advances in natriuretic peptides in congestive heart failure. Expert Opin Investig Drugs 2004; 13(6): 643–652. [DOI] [PubMed] [Google Scholar]
  • 30. Kubo M, Nakaya Y, Matsuoka S, Saito K, Kuroda Y: Atrial natriuretic factor and isosorbide dinitrate modulate the gating of ATP‐sensitive K+ channels in cultured vascular smooth muscle cells. Circ Res 1994; 74(3): 471–476. [DOI] [PubMed] [Google Scholar]
  • 31. Price JM, Hellermann A: Inhibition of cGMP mediated relaxation in small rat coronary arteries by block of CA+ + activated K+ channels. Life Sci 1997; 61(12): 1185–1192. [DOI] [PubMed] [Google Scholar]
  • 32. Mehra MR, Maisel A: B‐type natriuretic peptide in heart failure. Diagnostic, prognostic, and therapeutic use. Crit Pathw Cardiol 2005; 4: 10–20. [DOI] [PubMed] [Google Scholar]
  • 33. Forfia PR, Lee M, Tunin RS, Mahmud M, Champion H, et al.: Acute phosphodiesterase 5 inhibition mimics hemodynamic effects of B‐type natriuretic peptide and potentiates B‐type natriuretic peptide effects in failing but not normal canine heart. J Am Coll Cardiol 2007; 49(10): 1079–1088. [DOI] [PubMed] [Google Scholar]
  • 34. Kuhn M: Structure, regulation, and function of mammalian membrane guanlyl cyclase receptors, with a focus on guanlyl cyclase‐A. Circ Res 2003; 93: 700–709. [DOI] [PubMed] [Google Scholar]
  • 35. Yoshimura M, Yasue H, Ogawa H: Pathophysiological significance and clinical application of ANP and BNP in patients with heart failure. Can J Physiol Pharmacol 2001; 79(8): 730–735. [PubMed] [Google Scholar]
  • 36. McBride BF, White CM: Acute decompensated heart failure: a contemporary approach to pharmacotherapeutic management. Pharmacotherapy 2003; 23(8): 997–1020. [DOI] [PubMed] [Google Scholar]
  • 37. Chen HH, Burnett JC Jr: The natriuretic peptides in heart failure: diagnostic and therapeutic potentials (review). Proc Assoc Am Physicians 1999; 111(5): 407–416. [DOI] [PubMed] [Google Scholar]
  • 38. Maisel AS, Krishnaswamy P, Nowak RM, McCord J, Hollander J, et al.: Rapid measurement of B‐type natriuretic peptide in the emergency diagnosis of heart failure. N Engl J Med 2002; 347(3): 161–167. [DOI] [PubMed] [Google Scholar]
  • 39. Krauser DG, Lloyd‐Jones DM, Chae CU, Cameron R, Anwaruddin S, et al.: Effect of body mass index on natriuretic peptide levels in patients with acute congestive heart failure: a ProBNP Investigation of Dyspnea in the Emergency Department (PRIDE) substudy. Am Heart J 2005; 149(4): 744–750. [DOI] [PubMed] [Google Scholar]
  • 40. Tang WHW, Girod JP, Lee MJ, Starling R, Young J, et al.: Plasma B‐type natriuretic peptide levels in ambulatory patients with established chronic symptomatic systolic heart failure. Circulation 2003; 108: 2964. [DOI] [PubMed] [Google Scholar]

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